Our goal is your complete satisfaction. Tell Us How We're Doing Click to select your rating on a scale of 1 (worst) to 10 (best), and share any additional comments you think we should know. Starred items require a response. 1. Overall Experience*Please rate your level of satisfaction with your overall experienceClick to choose10 (very satisfied)98765 (middle of the road)4321 (not at all satisfied)Not applicableOverall Experience CommentsRecognize one of our team members or tell us how we can improve2. Equipment Instruction*Please rate how satisfied you were with the instruction that was provided on using your equipmentClick to choose10 (very satisfied)98765 (middle of the road)4321 (not at all satisfied)Not applicableEquipment Instruction CommentsRecognize one of our team members or tell us how we can improve3. Level of Kowledge*Please rate how knowledgeable our care representative wasClick to choose10 (very knowledgeable)98765 (middle of the road)4321 (not at all knowledgeable)Not applicableLevel of Knowledge CommentsRecognize one of our team members or tell us how we can improve4. Delivery Time*Please rate your level of satisfaction regarding the time delivery of your orderClick to choose10 (very satisfied)98765 (middle of the road)4321 (not at all satisfied)Not applicableDelivery Time CommentsRecognize one of our team members or tell us how we can improve5. Recommendation*Based upon your experience, please rate how likely you are to recommend SuperCare HealthClick to choose10 (defintiely recommend)98765 (middle of the road)4321 (do not recommend)Not applicableRecommendation CommentsRecognize one of our team members or tell us how we can improve6. Other CommentsLet us know anything else on your mind we haven't coveredName First Last Location* City ZIP / Postal Code Problems or Issues? Please contact me to discuss issues identified above PhoneEmail NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Google+ (Opens in new window)
